Findings Of Fact The Petitioner is the Department of Health and Rehabilitative Services. The Respondent is Elizabeth Joseph, licensed at all times pertinent to these proceedings to operate Jas Manor, an adult congregate living facility in Miami, Florida. Petitioner's employee, Elizabeth Baller, conducted an inspection of the Respondent's facility on September 18, 1986, and discovered seven persons in residence. This number of individuals exceeded the licensed capacity of Respondent's facility by one person. Ms. Baller recited the initials of those residents present in Respondent's facility on that date. Respondent's composite exhibit number 1, consisting of what are alleged to be copies of admission and discharge records, corroborates Ms. Baller's finding. The Respondent was not present at the facility at the time of this inspection. The failure of the Respondent to limit the capacity of the facility to no more than six residents posed a potential threat to the well-being of the residents. The existence of the deficiency finding was discussed with the Respondent by Baller via telephone on September 26, 1986. Ms. Baller did not visit Respondent's facility on September 24, 1986 and is without any direct personal knowledge that the number of residents in the facility on that date exceeded the licensed capacity. In the absence of such direct testimony, Petitioner exhibit number 1, alleged to be a statement of deficiencies issued by Petitioner, is not corroborative or credited with probative value as to the existence of any deficiency of the licensed facility on September 24, 1986. Petitioner exhibit number 1 does not conform to the statutory requirements for a class III deficiency citation as specified in section 400.419(3)(c), Florida Statutes, in that the exhibit fails to set forth the time within which the deficiency is to be corrected. Ms. Baller conducted a follow up visit on November 21, 1986, which, she contends, revealed seven residents in the facility, and a continuation of the violation cited previously in September. This contention of Ms. Baller is not supported by the weight of the evidence. Respondent's denial of the continuation of the deficiency at that time is supported by the testimony of Christine Sassone who regularly visits the facility on behalf of the church attended by her and Respondent. Ms. Sassone works with the residents of Respondent's facility, teaching arts and crafts there every evening, Monday through Friday, from 3:30 or 4 P.M. until 8:30 or 9:00 P.M. She was present at the facility on September 18 and November 21, 1986. She attests that there were only six residents present on either occasion. It is her testimony that individuals in excess of the licensed capacity on both of the dates in question may have been visitors from a neighboring facility known as the "Vet's Nest" which abuts Respondent's property. While discounting Sassone's unsupported testimony regarding the number of residents present on September 18, 1986, her testimony and that of the Respondent establish the fact that only six residents were present at the time of the follow up visit by Baller. Notably, Respondent's exhibit number 1 which supported the Petitioner's finding of seven residents in Respondent's facility on September 18, 1986, corroborates the testimony of Respondent and Ms. Sassone establishing that such deficiency was cured by November 21, 1986. The evidence fails to establish that the violation of Respondent discovered on September 18, 1986, was a repeat offense. It is found that the offense was not a repeat offense.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED the Department of Health and Rehabilitative Services enter a final order finding the commission of a class III violation by Respondent, but assessing no civil penalty for the violation. DONE AND RECOMMENDED this 11th day of March, 1988, in Tallahassee, Leon County, Florida. DON W. DAVIS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904)488-9675 Filed with the Clerk of the Division of Administrative Hearings this 11th day of March, 1988. APPENDIX The following constitutes my specific rulings on findings of fact submitted by the parties. PETITIONER'S PROPOSED FINDINGS Included in findings 2 and 3. Included in finding number 3, except for the last sentence relating to the visit of November 21, 1986. This sentence is rejected as not supported by the weight of the evidence. Included in finding number 3 and 9, except for the last sentence which is rejected. Rejected as unnecessary. COPIES FURNISHED: Leonard T. Helfand, Esquire Department of Health and Rehabilitative Services 5190 N.W. 167th Street Miami, Florida 33014 Elizabeth Joseph Administrator Jas Manor 645 N.E. 131st Street North Miami, Florida 33161 Gregory L. Coler Secretary Department of Health and Rehabilitative Services 1323 Winewood Blvd. Tallahassee, Florida 32399-0700 John Miller, Esquire Department of Health and Rehabilitative Serviced 1323 Winewood Blvd. Tallahassee, Florida 32399-0700 Sam Power HRS Clerk Department of Health and Rehabilitative Services 1323 Winewood Blvd. Tallahassee, Florida 32399-0700
The Issue Whether Respondent committed the offenses described in the Administrative Complaint issued by Petitioner? If so, what penalty should be imposed?
Findings Of Fact Elenor's Retirement Home (Home) is a licensed adult congregate living facility located in Miami, Florida. Eric Peavy is the owner of the Home. His wife is the Home's administrator. In November, 1989, OLC personnel visited the Home to conduct a survey to determine compliance with licensure requirements. Resident contracts on file were reviewed. Three of the contracts reviewed contained neither a refund policy of the type specified in Chapter 10A- 5, Florida Administrative Code, a bed hold policy, nor a statement as to whether the Home is affiliated with any religious organization. A previous survey conducted by OLC personnel had revealed that resident contracts on file at the Home lacked these provisions. The Peavys were so notified and directed to take corrective action. They failed to do so within the mandated time frame. This deficiency still existed as of the November, 1989, survey. During the November, 1989, survey, an examination was also conducted of the medication records maintained at the facility. The records were incomplete. They did not contain daily, up-to-date information regarding the administration of medication to three of the Home's residents. A previous survey conducted by OLC personnel had revealed that the Home did not have complete, up-to-date records concerning the daily administration of medication to all of its residents. The Peavys were so notified and directed to take corrective action. They failed to do so within the mandated time frame. This deficiency still existed as of the November, 1989, survey. During the November, 1989, survey, OLC personnel observed a resident who required greater care than the Home was able to provide. The resident was incapable of doing virtually anything for herself. Among other things, she needed to be administered medication. The Home, however, did not have the licensed staff to provide this service. The resident was totally incontinent. Because of her physical condition, the resident was unable to participate in any of the social activities at the Home. The same resident had been observed at the facility during an earlier survey conducted in June of that year. Although the matter of the inappropriateness of the resident's continued placement at the Home had been raised during the survey, the resident was still at the facility when OLC personnel returned to the Home in November. During the November, 1989, survey, the Home's fire drill records were inspected. There was no record of any fire drills being conducted at the facility in September or October of that year. This was not the first time that OLC personnel had found a lack of documentation concerning the conducting of monthly fire drills at the Home. Such a deficiency had been uncovered during an October, 1988, survey of the Home. The Peavys were made aware of this deficiency at that time. The Peavys were given written notice of the deficiencies found during the November, 1989, survey. OLC personnel revisited the Home in February, 1990, and discovered that all of the deficiencies found during the November, 1989, survey had been corrected.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby recommended that Petitioner enter a final order finding Respondent guilty of the violations alleged in the Administrative Complaint, imposing a civil penalty in the amount of $1,000 for these violations and giving the Home a reasonable amount of time within which to pay this penalty. RECOMMENDED in Tallahassee, Leon County, Florida, this 6th day of May, 1991. STUART M. LERNER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 6th day of May, 1991.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Prior to its licensure as an adult congregate living facility, the respondent H & E Guest Home received an initial inspection by HRS on June 24, 1985. Various deficiencies were cited during this visit and all such deficiencies were corrected by September 10, 1985, the date of the revisit by HRS. Among the deficiencies cited by HRS were that "the facility income and expense records were not available for review," denominated by HRS as an "unclassified" deficiency, and that "menus were not dated and planned one week in advance," denominated as a Class III deficiency. At the time of this initial survey on June 24, 1985, there were no residents in the respondent's facility as it was not yet licensed or opened for operation as an adult congregate living facility. On June 17, 1986, HRS performed an annual survey on respondent's facility. During this survey, several deficiencies were found. As pertinent to the charges in this proceeding, HRS found that there were no fiscal records relating to the facility's financial operating status available at the facility site for review. This deficiency was denominated by HRS as a Class III repeat deficiency. The other repeat deficiency noted, also denominated as Class III, was that menus were not dated and planned one week in advance. Residents were in the respondent's facility on June 17, 1986. HRS proposes to levy a fine of $250.00 for the fiscal records deficiency, and a fine of $200.00 for the deficiency relating to menus. According to HRS, the impacts upon patients resulting from such deficiencies are, respectively, "without the records it would be difficult to determine the financial stability of the facility," and "it would be difficult to maintain a sufficient food supply, and the residents would not be aware of their meals in advance."
Recommendation Based upon the findings of fact and conclusions of law recited herein, it is RECOMMENDED that the Administrative Complaint be DISMISSED, without prejudice to HRS to conduct an unannounced visit to the respondent's facility to determine if the cited deficiencies have been corrected. Respectfully submitted and entered this 6th day of October, 1987, in Tallahassee, Florida. DIANE D. TREMOR Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 6th day of October, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-1374 The proposed findings of fact submitted by the petitioner are accepted, except as follows: 2. Partially accepted; however, there was no evidence that the corrections were not timely made. 4. Accepted, but not included as irrelevant and immaterial to the issues in dispute. COPIES FURNISHED: Gaye Reese, Esquire Senior Attorney Office of Licensure and Certification 7827 North Dale Mabry Highway Tampa, Florida 33614 Aubrey E. Estes 3116 Ninth Street, East Bradenton, Florida 33508 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Sam Power, Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
Findings Of Fact Petitioner Department of Health and Rehabilitative Services (hereinafter the Department), filed an Administrative Complaint alleging that Respondent, The Villa Cabana, Inc. (hereinafter Villa Cabana), violated minimum licensing standards for an Adult Congregate Living Facility in the following manner: The Respondent failed to assure, and have available documentation, that each person employed by the facility, who may come into contact with potentially infectious materials is trained in infection control procedures for blood and other bodily fluids. It was further alleged that the deficiency was found to exist during the surveys completed on July 31, 1989 and July 18, 1990. By letter dated January 5, 1991, the administrator for Villa Cabana disputed the allegations set forth in the Administrative Complaint and requested a formal hearing. During the hearing, the Department presented one witness and filed two exhibits, which were admitted into evidence. The Respondent called two witnesses, and showed the Hearing Officer the nursing license of Floretta Young. A transcript of the proceeding was not ordered. Both parties waived their opportunity to submit proposed findings of fact.
Recommendation Based upon the foregoing, it is RECOMMENDED: The Respondent be found guilty of having violated Rule 10A-5.019(5)(h), Florida Administrative Code, during the survey conducted on July 18, 1990, as alleged in the Administrative Complaint. The alleged violation of the same Florida Administrative Code provision which was recorded in the survey conducted July 31, 1989, be considered as an improperly classified deficiency. The July 18, 1990 violation be deemed the facility's first offense of Rule 10A-5.019(5)(h), Florida Administrative Code. The civil penalty which the Department seeks to assess against the facility administrator be dismissed as such penalties may only be imposed if the violation is a repeated offense. DONE and ENTERED this 24th day of April, 1991, in Tallahassee, Leon County, Florida. VERONICA E. DONNELL Hearing Officer Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 Filed with the Clerk of the Division of Administrative Hearings this 24th of April, 1991. COPIES FURNISHED: Paula M. Kandel, Esquire HRS - Office of Licensure and Certification 7827 North Dale Mabry Highway Tampa, Florida 33614 Keith Young, Administrator The Villa Cabana 2600 - 4th Street South St. Petersburg, Florida 33705 R. S. Power, Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700 Linda K. Harris, Esquire General Counsel Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
The Issue The issues for determination are whether Island Retirement Home, Inc., committed the offenses set forth in the Administrative Complaint and, if so, what action should be taken; and whether Island Retirement Home, Inc.'s license, as an Assisted Living Facility, should be renewed.
Findings Of Fact It is undisputed that Island Retirement Home, Inc. (Island) is licensed, as an Assisted Living Facility (ALF), by the Agency for Health Care Administration (AHCA). Island is licensed for six beds and is located at 2906 West Island Drive, Miramar, Florida. On May 16, 1997, Island was surveyed by AHCA for relicensure. At that time Island had two residents at the facility. At the survey on May 16, 1997, AHCA's surveyor found numerous deficiencies of which Island was notified.2 Furthermore, Island was notified that it had to correct the deficiencies by June 15, 1997. A follow-up visit was conducted by the same surveyor on July 7, 1997.3 Two deficiencies were found regarding fiscal records and financial stability. At the relicensure survey, AHCA's surveyor was unable to review Island's fiscal records and assess Island's financial stability in that Island's fiscal records were not maintained at the facility. Island's fiscal records were not provided to the surveyor even after the survey. At the follow-up survey, the deficiencies remained in that fiscal records were again unavailable. The deficiencies were classified as Class III deficiencies. One deficiency was found regarding refunds to residents. At the relicensure survey, there were no records regarding refunds to residents. As a result, the surveyor was unable to verify refunds, if any, to residents. Entries regarding deposits and refunds were made by Island on the resident logs. However, no resident made a deposit so no refund was due any resident; therefore, no records, showing a refund to residents, existed. At the follow-up survey, the deficiency remained in that records were again unavailable. The deficiency was classified as a Class III deficiency. One deficiency was found as to maintaining liability insurance. At the relicensure survey, AHCA's surveyor was informed that Island did not maintain documentation of its liability coverage at the facility, resulting in the surveyor being unable to determine Island's liability status. However, when an ALF applicant applies for renewal, proof of liability insurance must accompany the application. No evidence was presented that such proof did not accompany Island's renewal application. At the follow-up survey, the deficiency remained in that liability insurance records were again unavailable. The deficiency was classified as a Class III deficiency. One deficiency was found regarding the posting of inspection reports. At the relicensure survey, none of the inspection reports from AHCA were posted at Island for public review. At the follow-up survey, the deficiency remained in that AHCA'S inspection reports were still not posted. The deficiency was classified as a Class III deficiency. One deficiency was found as to a written procedure for contacting a resident's family in emergency situations. At the relicensure survey, Island did not have available for review such a written procedure. Because of the small number of residents served by Island, Island looks to a resident's application package as to who to contact on behalf of the resident in an emergency situation. Regardless, Island did not have a written procedure for contacting a resident's family in emergency situations. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to records and documents. Being unable to review a written procedure, if any, AHCA's surveyor terminated the survey. The deficiency was classified as a Class III deficiency. One deficiency was found regarding personnel records showing that staff were appropriately trained to provide services to residents. At the relicensure survey, Island did not have at the facility any personnel records for review showing that its staff had the appropriate ALF training to provide services to the residents. At the follow-up survey, the deficiency remained uncorrected. Personnel records were available for Island's staff who were exempt from ALF training requirements; however, again, no records were available for one staff member showing that the ALF training requirements were fulfilled or that the person was exempt. The deficiency was classified as a Class III deficiency. One deficiency was found relating to documentation showing that staff, who may come into contact with potentially infectious diseases, had received training in infection control measures. At the relicensure survey, one of Island's staff members assisted a resident and, because of the resident's needs, the staff member could come in contact with a potentially infectious disease. Island had no documentation showing that the staff member had received the appropriate training in infection control measures. Also, according to the staff member, no training had been received. At the follow-up survey, the deficiency remained uncorrected. Personnel records were available and were reviewed; however, none of the personnel records showed that the staff had received training in infection control measures. The deficiency was classified as a Class III deficiency. One deficiency was found regarding the posting of the current health inspection report completed by the county public health unit. At the relicensure survey, Island did not post for public review the current health inspection report completed by the county public health unit. Because of Island's small size in physical structure and the number of residents served, the county public health unit inspected Island once a year. The only inspection report available was one completed by the county public health unit in 1996. At the follow-up survey, the deficiency remained in that Island did not have a current inspection report posted even though a current health inspection had been performed. The deficiency was classified as a Class III deficiency. One deficiency was found regarding a current health assessment for each resident's status and condition. At the relicensure survey, Island did not have a current accurate health assessment for one resident (Resident No. 1) as to that resident's status and condition. At the follow-up survey, the deficiency was not corrected. The health assessment was again inaccurate for the resident, who was now Resident No. 4, in that the assessment had not been updated. Also, for another resident (Resident No. 3), no health assessment had been performed even though the resident had been a resident at Island for at least 30 days. The deficiency was classified as a Class III deficiency. One deficiency was found as to the assessment of each resident's ability to self-preserve, or to get themselves out of the facility at the time of an emergency. At the relicensure survey, Island had not assessed its only two residents as to self-preservation. Island's basis for the non-assessment was that no forms were available for such an assessment. At the follow-up survey, the deficiency was not corrected. The deficiency was classified as a Class III deficiency. One deficiency was found regarding each resident satisfying criteria for admission and continued residency in the facility. At the relicensure survey, one resident (Resident No. 1) failed to meet the criteria for continued residency. Resident No. 1 required assistance with all activities of daily living (ADLs), except eating, and had been bedbound for several months. Further, Resident No. 1's health assessment indicated a no-salt added diet, but Island failed to provide the Resident with such a diet, thereby, failing to meet the Resident's dietary needs. Additionally, from the review of Resident No. 1's records, the surveyor determined that the Resident had lost 16 pounds in 10 days and had lost 60 pounds since admission in October 1995, indicating that Island was no longer able to provide for the needs of the Resident. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to records and documents. Being unable to review the records or documents, AHCA's surveyor terminated the survey. AHCA did not present evidence as to the classification of the deficiency. One deficiency was found as to inappropriately retaining the placement of a resident. At the relicensure survey, one resident (Resident No. 1) was found to be inappropriately placed. Resident No. 1 had been bedbound for several months. Within seven days of being bedbound, Respondent had failed to attempt to discharge and place Resident No. 1 in a more appropriate facility to meet Resident No. 1's needs. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to the entire facility. Being unable to inspect the facility, AHCA's surveyor terminated the survey. However, the surveyor did determine that Resident No. 1, who was now Resident No. 4, was still residing at the facility and was still bedbound. The deficiency was classified as a Class II deficiency. One deficiency was found regarding documentation showing that the administrator met certain qualifications as an administrator. At the relicensure survey, Island did not have for review the personnel records of its administrator. The records were not maintained at the facility. At the follow-up survey, the administrator's personnel file was available for review and showed that the administrator was qualified to be an administrator. However, the personnel file failed to contain documentation showing that the administrator had obtained the necessary updated training, i.e., CORE updates, to continue to meet the qualifications of an administrator. The deficiency was classified as a Class III deficiency. Three deficiencies were found regarding documentation showing that the administrator had provided training to the staff on CORE subjects in job duties; and that the staff, who provided direct care, had received the required minimum training. At the relicensure survey, there were no training records. According to Island's administrator, no training records on the staff existed. At the follow-up survey, Island's administrator informed the surveyor that, again, no training records were available. Even though some personnel records were available, there was no documentation showing the required training. The deficiencies were classified as Class III deficiencies. One deficiency was found as to having a written work schedule available. At the relicensure survey, Island did not have a written work schedule available. At the follow-up survey, the deficiency remained uncorrected. A written work schedule was available; however, the work schedule showed one person, the same person, on duty 24- hours a day, seven days a week. Even though Island's administrator informed the surveyor that she assisted the staff person shown on the work schedule every day with resident care, the administrator was not listed on the schedule and no other person was reflected on the work schedule as a back-up staff person.4 Moreover, the administrator's assistance would not be continual in that the administrator worked at least one day a week at a nursing home approximately 20 minutes from Island, and she owned and operated a home health agency. The deficiency was classified as a Class III deficiency. One deficiency was found regarding a written appointment or designation of someone to be in charge of the facility during the administrator's temporary absence when residents are at the facility. At the relicensure survey, only one staff person was present and there was no written documentation showing the appointment or designation of the staff person or any other person to be in charge of the facility during the administrator's temporary absence. The administrator informed the surveyor that no person had been designated in writing to be in charge of the facility during her temporary absence. At the follow-up survey, the deficiency was not corrected. There was no documentation showing a written appointment or designation. Moreover, no person had been appointed or designated by the administrator. The deficiency was classified as a Class III deficiency. One deficiency was found regarding staff receiving required HIV and AIDS training. At the relicensure survey, Island had no documentation showing that the staff had received required training in HIV and AIDS. The administrator is a registered nurse and was required by a hospital at which she was employed prior to the relicensure survey to obtain HIV and AIDS training. Even though the administrator had the required training, there was no documentation at the facility to show that she had the required training and her HIV and AIDS training was not within the knowledge of the surveyor. At the follow-up survey, the deficiency remained. Island had no documentation showing the required training in HIV and AIDS had been received by its staff. The deficiency was classified as a Class III deficiency. One deficiency was found as to insufficient staff to meet the needs of the residents. At the relicensure survey, through observation, interviews of the residents, and review of the evening schedule, the surveyor determined that Island had insufficient staff to address the needs of the residents who consisted of two residents. One resident was bedbound and, at a minimum, two staff members were required to assist the resident in and out of bed, particularly in an emergency; but only one staff person was scheduled to work. At the follow-up survey, the deficiency remained. The bedbound resident continued as a resident at the facility, but only one staff person was present. The deficiency was classified as a Class III deficiency. One deficiency was found regarding documentation showing the method of medication management on a resident's health assessment. At the relicensure survey, the method of administration of medication for one resident had not been documented by the health care provider. Island failed to ensure that the method of administration was available to the resident. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to records. Being unable to review the records, AHCA's surveyor terminated the survey. The deficiency was classified as a Class III deficiency. One deficiency was found regarding the signing of medication administration records (MARs) by the staff person, who supervises the residents self-administering their medication, and at the time the medication is self-administered. At the relicensure survey, even though a staff person, at times, supervised residents when they self-administered their medication, that same staff person did not sign the MARs.5 The administrator, who did not supervise the self-administration medication, signed the MARs. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to records. Being unable to review the records, AHCA's surveyor terminated the survey. The deficiency was classified as a Class III deficiency. One deficiency was found as to ensuring that medication is timely refilled. At the relicensure survey, a resident's (Resident No. 2) prescribed heart medication was empty. The staff was not aware as to whether the administrator had ordered a refill. However, the administrator had notified the resident's family member, who was responsible for providing the resident's medication, that the medication needed refilling, and the administrator was awaiting the medication at the time of the survey. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to inspect the facility and records. Being unable to inspect the facility and records, AHCA's surveyor terminated the survey. AHCA did not present evidence as to the classification of the deficiency. One deficiency was found as to appropriate services being provided to meet the needs of residents. At the relicensure survey, Island's staff person, who prepared most of the meals, was not aware that Island's only two residents were on a no-salt diet. One of the food items for each evening meal prepared by the staff person contained salt, and the staff person was unaware of the food item's salt content. Further, Island's staff member was unaware of the name and location of a resident's (Resident No. 2) day program and was, therefore, unaware of the resident's whereabouts. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to inspect the facility and records. Being unable to inspect the facility and records, AHCA's surveyor terminated the survey. AHCA did not present evidence as to the classification of the deficiency. One deficiency was found as to required activities being provided for the residents. At the relicensure survey, a determination as to whether required activities were being provided to the residents could not be made. An activities calendar was posted, however, the calendar did not reflect the time of day and duration of the activities. At the follow-up survey, the deficiency was uncorrected. Even though the activities calendar was posted and reflected the duration of the activities, the calendar did not reflect the time of day of the activities. AHCA did not present evidence as to the classification of the deficiency. One deficiency was found as to maintaining sufficient non-perishable foods in case of an emergency. At the relicensure survey, Island did not have a week's supply of non-perishable foods in case of an emergency for its two residents. The administrator had made plans to replenish the non-perishable foods the following week. At the follow-up survey, the surveyor was unable to determine if the deficiency was corrected. Island's director and administrator disagreed with the manner in which AHCA's surveyor was conducting the survey and came to distrust the surveyor to the extent that they denied the surveyor access to inspect the facility and records. Being unable to inspect the facility and records, AHCA's surveyor terminated the survey. The deficiency was classified as a Class III deficiency. One deficiency was found regarding Island's furniture and furnishings being clean, in good repair, and reasonably attractive. At the relicensure survey, Island's carpet, throughout the facility, was stained with unidentifiable brown and black stains. Island's administrator indicated that the floors would be tiled, instead of carpeted, which would alleviate the problem. Additionally, in one resident's (Resident No. 1) room, both doors to the closet were off and leaning against the back wall of the closet. At the follow-up survey, the deficiency was uncorrected. The deficiency was classified as a Class III deficiency. One deficiency was found regarding a current satisfactory fire safety inspection report being available for review. At the relicensure survey, Island did not have a current satisfactory fire safety inspection report for review. At the follow-up survey, the deficiency was uncorrected. The deficiency was classified as a Class III deficiency. Island has been licensed since 1993. During all the relicensure surveys, the only deficiencies cited have been the deficiencies in this present matter. Throughout its licensure, Island was continuously used by the former Department of Health and Rehabilitative Services as a facility to place residents, who were difficult to manage, on a temporary basis. Due to multiple deficiencies being cited at the relicensure survey, AHCA recommended that Island's administrator obtain additional training. At the follow-up survey, Island's personnel files did not show that the administrator had obtained the additional training, and AHCA cited this failure to obtain the additional training as a deficiency. AHCA failed to demonstrate that the deficiency was an uncorrected deficiency for which Island was cited at the relicensure survey.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a final order: Imposing an administrative fine of $300 for each demonstrated violation consisting of a Class III deficiency as to the Administrative Complaint, totalling $6,100. Issuing Island Retirement Home, Inc., a conditional license for a 6-month period under terms and conditions as determined by the Agency for Health Care Administration. DONE AND ENTERED this 17th day of July, 1998, in Tallahassee, Leon County, Florida. ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 17th day of July, 1998.
